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Cesarean section in cattle
Nichols S.
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Introduction: Dystocia in dairy and beef cattle are fairly common (1.1-6.8% of all calvings). Vaginal manipulation can resolve the dystocia. However, in cases of fetal disproportion, cervical inertia, malformation or complicated malposition, a c-section will be necessary.
Preoperative treatments: Preoperative antibiotics, such as procaine penicillin, should be given. It is also appropriate to give a NSAID, such as meloxicam. The surgery site is clipped and prepared appropriately for surgery (washed and scrubbed). Most c-sections are done with the cow standing and restrained in a contention chute. Sedation is rarely needed.
For a standing procedure, the flank is anesthetized by paravertebral block (proximal or distal), inverted L or line block. The technique chosen is often based on surgeon experience.
Surgical approaches: Typically, the left paralumbar fossa is used to access the uterus. From this approach, the rumen acts as a barrier to keep the jejunum in the abdomen. Exteriorization is crucial with a dead calf. However, with a live calf that had minimal obstetrical manipulation, the uterus can be opened within the abdomen.
Ventral approaches are possible in cattle. They are usually performed on dead or emphysemateous calves. The ventral-midline and the right paramammary have been described in beef cattle. Those are more difficult to execute on dairy cattle because of the size of the udder and the massive vascular network. The para-mammary/inguinal approach can be used in dairy cattle. The ventral approach provides a more direct access to the uterus.
Surgical techniques: Hysterotomy is performed on the greater curvature. The calf is extracted gently to avoid tearing the uterus. With the uterus still exteriorized, the uterus is checked for another calf. The placenta, if detached, is removed. If it is still attached, scissors are used to remove the part that comes out of the hysterotomy. A double inverting pattern is the technique of choice for closure of the uterus. The patterns that can be used are continuous Utrech, Cushing or lembert. On the second layer, it is important to burry the knots to avoid adhesions. Absorbable suture material of USP 1 is appropriate. Some advocate the use of monofilament instead of multifilament to decrease the drag effect. If the latter is used, it is important to push the tissue over the suture rather than pull the suture through the tissue to avoid the dragging effect and tearing of the uterus.
Before being returned in the abdomen, the uterus is cleaned of blood clots and debris. If the surgery was contaminated and if possible, the abdomen should be thoroughly lavaged with sterile isotonic solution. Ideally, the lavage solution is evacuated, by massage or by suction prior to closing the abdomen.
Postoperative treatments: Antibiotics should be continued and readjusted according to the surgical findings (live vs dead calf, clean contaminated vs contaminated surgery) and any co-morbidities occurring (mastitis, metritis, etc). NSAID should be given as needed and according to the general status of the cow.
The postoperative period following a c-section performed to extract an emphysematous fetus is challenging. Intravenous fluids, broad spectrum antibiotics and oral transfaunation are often necessary for the first postoperative days.
Complications and Prognosis: The status of the calf has an impact on the severity of the postoperative complications. The most severe complication would be peritonitis. Retained fetal membrane is another complication. It needs to be treated more aggressively because the hysterotomy site can be an opening and cause secondary peritonitis. According to Lyons et al, the presence of retained membrane has a negative impact on the survival of cows 14 days after the procedure.
According to Lyons et al, exteriorizing the uterus and removing the abdominal blood clots during surgery has a pos- itive impact on the survival of the cow. Also, c-section done because of feto-pelvic disproportion of a female calf has a positive impact on cow survival.
Tenhagen et al, showed that cows undergoing a c-section produce less milk at the beginning of lactation and are more likely to be open at 200 DIM. Therefore, they are more likely to be culled when compared to a control group.
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Affiliation of the authors at the time of publication
Montreal University, Canada
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